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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418559
Report Date: 10/11/2024
Date Signed: 10/11/2024 03:12:32 PM


Document Has Been Signed on 10/11/2024 03:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:VOLUNTEERS OF AMERICA, MONA HOUSE HEAD STARTFACILITY NUMBER:
197418559
ADMINISTRATOR:BATTINA BRAVFACILITY TYPE:
850
ADDRESS:13124 MONA BOULEVARDTELEPHONE:
3109330728
CITY:COMPTONSTATE: CAZIP CODE:
90222
CAPACITY:56CENSUS: 29DATE:
10/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Battina BrayTIME COMPLETED:
02:15 PM
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The Licensing Program Analyst (LPA), T. Tran, conducted a site inspection to follow up on a case incident management which occurred on 09/16/2024. The Monterey Park Southwest Childcare Regional Office received the incident report on 9/16/24. LPA met with site supervisor, Battina Bray and toured the facility inside and outside. LPA observed proper care and supervision.

LPA reviewed file and video footage. LPA obtained the facility roster, training materials/staff attendance, and other document.

LPA conducted the interview with staff, children, and other. Based on the information that were gathered through observation and interviews with staff, children, and other. On the day of the incident, there were three staff supervised 20 children. During morning outdoor play, C1 (see LIC811) ran up the play structure then fell forward hitting the mouth against the steps. Medical attention required. Paramedics and parent were contacted. According to the available information, it does not appear this incident was the result of a Title 22 violation for lack of care and supervision.

No deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Battina Bray.

SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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